ill Bradley has scored political points for painting his health care agenda as ''bold'' while deriding Al Gore's $312 billion health plan as ''timid.'' Under close examination, Bradley's rhetoric does not hold up - and his health plan falls short in comparison to Gore's.
Gore's plan represents the biggest public investment in health care since the creation of Medicare and Medicaid. He would provide access to coverage for every child in America, make health insurance more affordable for millions of adults, and put medical decisions back in the hands of doctors and patients rather than administrators.
With more experience under his belt fighting to improve health care, Gore has crafted a more realistic plan than Bradley. It achieves many of the results aimed for in Bradley's proposal, but it does so at a much lower cost.
Because Gore's plan is more achievable, it is more likely to fulfill its promise of expanding coverage and improving care. In five critical areas, Gore's plan makes more sense than Bradley's.
Coverage: Bradley has oversold his plan, claiming that it achieves universal coverage when it does not. According to an independent analysis by Dr. Kenneth Thorpe of Emory University based on information supplied by Bradley's campaign, the Bradley plan would cover only 15 million new people, not the 30 million he claims, meaning it would reach 89 percent of the population. Gore's plan would insure 88 percent of the population.
Two-thirds of the benefits under Bradley's plan would go to people who already have insurance, while Gore wisely targets coverage at those who are uninsured.
Cost: According to the same study, Gore's plan achieves nearly the same coverage as Bradley's but at one-third the price. The Bradley plan would cost the federal government $1.1 trillion over 10 years, which is about the size of the projected budget surplus for the same period. This leaves little to invest in other critical priorities, such as education.
Gore's plan carries a manageable price tag of $312 billion over the same period, according to Thorpe. This would leave room for Gore's ambitious education proposal and other important investments. Bradley has left little room to invest more in public schools or other areas.
Medicaid: Bradley denies it, but his plan would provide fewer benefits for low-income and disabled people who currently receive coverage under Medicaid.
Bradley would ''mainstream'' current Medicaid recipients, scrapping the program and giving low-income adults a $150 monthly subsidy toward the purchase of private health insurance.
A subsidy of $150 a month will not come close to purchasing the vast array of benefits provided under Medicaid. People on Medicaid rightfully fear getting lost in the mainstream of the private health insurance market. HMOs are not known for their generosity toward people with significant health needs.
Gore recognizes that Medicaid is not perfect. He proposes strengthening the program, which provides an array of benefits to some 40 million people - benefits not easily obtained in the private health insurance market. He preserves Medicaid's benefits and allows the program to cover home- and community-based care for people with severe disabilities and other long-term health care needs. This approach allows people with disabilities to live at home and be part of their communities rather than be placed in institutions.
Medicare: As the baby boom generation retires in the coming decades, the number of people relying on Medicare is expected to double. To ensure the continued solvency of the program, Gore responsibly devotes 15 percent of the budget surplus to the Medicare Trust Fund. Bradley does not devote a dime to shore up Medicare.
In a recent debate, Bradley weakly defended this major oversight by saying that tomorrow's seniors will be healthier than today's because ''they have been exercising.'' In the Senate, Bradley supported means testing and raising the retirement age of Medicare. Gore opposes both approaches because they threaten the broad-based public support of this essential program.
Prescription drugs: With Americans paying the highest prices in the world for prescription drugs, Gore has offered a sensible plan to lower drug prices by bringing lower-priced generic versions to market faster. Generics can offer high-quality alternatives to name brand drugs at up to half the price.
Gore has a long history of fighting the powerful pharmaceutical industry in order to give consumers better access to generic drugs. Bradley has no plan for lowering prescription costs on the private market.
In addition to aiming for lower drug prices, Gore's plan helps seniors with a new, no-deductible prescription drug benefit under Medicare. Bradley offers drug coverage under Medicare but with a $500 deductible. This won't help the average senior, whose prescription costs fall below $500.
On balance, Gore has offered an equally ambitious but more realistic health plan than Bradley. Gore's plan would make a real difference for millions of uninsured Americans, protect health care for HMO patients, and make important advances toward the ultimate goal of universal health insurance.
Bradley's plan is a costly political promise that he won't be able to keep.
Walter Hoerman is a pediatrician in Rochester, N.H., and a member of Al Gore's New Hampshire Health Care Advisory Board.
